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Abstract:
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As nursing homes become a dominant setting for death in the United States, palliative care must be integrated into daily nursing home practices. Improvements in this area will be better evaluated if researchers can assess the degree to which nursing homes provide palliative care. Therefore, the purpose of this study was to develop and validate a measure of palliative care in nursing homes. Items for the Palliative Care Process Measure were written to represent one of three broad conceptual domains: cognitive, e.g., knowledge related to common symptoms of dying residents; affective, e.g., attitudes toward death; and actions, e.g., interventions at the end of life. Seventy-nine items were tested in 24 nursing homes with direct care staff (N = 717). Following revision of the instrument based on theoretical and empirical methods including factor analysis, 21 items comprised 5 subscales representing the affective and action domains. The 5 subscale model resulted in a CFI of .93, indicating excellent fit of the model to the data. Cronbach’s alphas for the subscales ranged from .55 to .78. An additional 14 criterion-referenced items addressed the knowledge domain. Evidence for construct validity was demonstrated by the ability of subscales to discriminate among staff and facilities and by hypothesis testing with an additional sample of 5 nursing homes (N = 26 staff). While evaluation of the tool is ongoing, the Palliative Care Process Measure provides an innovative instrument for researchers to study relationships between palliative care processes and resident outcomes at the end of life. |
